Intraoperative systolic blood pressure variability predicts 30-day mortality in aortocoronary bypass surgery patients

Solomon Aronson, Mark Stafford-Smith, Barbara Phillips-Bute, Andrew Shaw, Jeffrey Gaca, Mark Newman

Research output: Contribution to journalArticlepeer-review

86 Scopus citations

Abstract

Background: Few data support an association between blood pressure variability and clinical outcomes during cardiac surgery. We tested the hypothesis that intraoperative systolic blood pressure variability outside a targeted blood pressure range predicts 30-day mortality in patients undergoing cardiac surgery. Methods: Electronically captured blood pressure data from 7,504 consecutive coronary bypass surgery procedures between September 1, 1996, and December 31, 2005, were divided into development and validation cohorts. Systolic blood pressure variability episodes outside a blood pressure range (e.g., higher than 135 or lower than 95 mmHg) were characterized by number of episodes, magnitude of episode, duration of episode, and magnitude × duration of excursion (i.e., area under the curve). Multiple logistic regression analysis was used to assess 30-day mortality association. The most predictive mortality risk characteristic and blood pressure range was tested in the validation cohort. Results: A total of 3.1 million intraoperative blood pressure evaluations were analyzed. Systolic blood pressure variability was derived in 5,038 patients and validated in 2,466 patients (8% without cardiopulmonary bypass and 6% with valve procedure). Among all tested indices of blood pressure variability, mean duration of systolic excursion (outside a range of 105-130 mmHg) was most predictive of 30-day mortality (odds ratio = 1.03 per minute, 95% CI 1.02-1.39, P < 0.0001). Conclusions: Intraoperative blood pressure variability is associated with 30-day postoperative mortality in patients undergoing aortocoronary bypass surgery.

Original languageEnglish
Pages (from-to)305-312
Number of pages8
JournalAnesthesiology
Volume113
Issue number2
DOIs
StatePublished - Aug 2010

Bibliographical note

Funding Information:
Supported by funding from The Medicines Company, 4 Sylvan Way, Parsippany, New Jersey (to Dr. Aronson), from Duke University for work contracted by The Medicines Company (to Dr. Stafford-Smith), from the Duke Clinical Research Institute–Global Perioperative Research Organization for work contracted by The Medicines Company (to Dr. Newman). Drs. Aronson and Stafford-Smith contributed equally to this work.

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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